| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,063 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,483 |
1,402 |
$54K |
| D1120 |
Prophylaxis - child |
861 |
826 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,174 |
1,139 |
$19K |
| D4910 |
|
232 |
232 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
391 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,716 |
1,733 |
$11K |
| D0274 |
Bitewings - four radiographic images |
799 |
771 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,607 |
1,518 |
$6K |
| D1110 |
Prophylaxis - adult |
75 |
75 |
$5K |
| D9430 |
|
40 |
39 |
$872.00 |
| D0272 |
Bitewings - two radiographic images |
54 |
53 |
$302.00 |
| D1999 |
|
117 |
92 |
$76.00 |